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HERPES TYPE-2 VIRUS AND CARCINOMA OF THE CERVIX UTERI IN NIGERIANS: IMMUNOVIROLOGICAL STUDIES
(1976-03) ADELUSI, B.
In the search for the etiology of carcinoma of the cervix uteri, various factors have been implicated by various workers. The disease has been shown to have a venereal origin, following on its significant association with coital characteristics. These include early Initiation into hetero-sexual acts and frequency of coitus, multiplicity of coital Partners, multiparity, low socio-economic standards, venereal diseases and circumcision. Extensive epidemiologic studies have indicated that a "venoreally transmitted factor" might be responsible for the introduction of the squamous cell variety of the malignant disease. Recently, a strain of Herpes Simplex virus, antigenically distinct from the strain commonly associated with oral lesions, and designated Genital Herpes or Herpes Type-2 (HT-2) virus, was shown to be venereally transmitted, and might have oncogenic potentialities on the cervix. At the time the present studies were contemplated, little was documented about the clinical and histopathologic presentation of Carcinoma of the cervix in Ibadan. There was also no knowlege of the prevalence of Herpes Type-2 virus antibodies in the population, nor of the precise relationship, if any, of the virus to carcinoma of the cervix uteri in Ibadan. It was clear however, as a result of the work Edington and Maclean (1965) that carcinoma of the cervix uteri is very common in Ibadan, where it was shown to form the commonest female malignancy. Clinical, cytologic, histopathologic and immuno-virologic studies were undertaken to see if indeed carcinoma of the cervix uteri has a venereal origin, and to ascertain whether or not there is any association between the malignancy and HT-2 virus infection in Ibadan. In addition, sero-epidemiologic studies were also undertaken to determine the prevalence of HT-2 virus antibodies in various sectors of the Population. Evidence was provided to show that coital practice was a significant correlate of carcinoma of the cervix in Ibadan. Furthermore, Imuno- fluorescence and complement fixation tests were two Parameters used to provide evidence that Herpes Type-2 virus is associated with the disease, in that carcinoma of the cervix patients possessed significantly levels of antibodies against HT-2 virus as compared with patients having extra-cervical pelvic, and extra-pelvic malignancies and healthy Controls. In addition, HT-2 virus antigens were detected by immunofluorescence tests in the exfoliative cervical cells from all patients with carcinoma of the cervix, whereas no such virus antigens were found in exfoliated cervical cells from healthy Controls. In was concluded, that the observed association between HT-2 virus and carcinoma of the cervix in agreement with other studies, and the fact that the virus was not associated with other extra-cervical malignancies in this environment, indicate a significant relationship. Even though this may not necessarily be an etiologic one, the precise relationship of the virus and the malignancy would have to await further investigation.
CIRCULATING TUMOUR ASSOCIATED ANTIGENS AS AID TO EARLY DIAGNQSIS OF CARCINOMA OF CERVIX
(1982-10) ADELUSI, B.
Earlier studies by this author in 1976 provided evidence of an association between an infective, sexually transmitted agent, the Herpes Simplex Virus Type-2 (HSV—2) and human carcinoma of the cervix, irrespective of geographic location or ethnic origin of the individuals. Similarly, HSV-2 related antigens were demonstrated by the indirect immuno-fluorescent technique in desquamated cells of carcinoma of the cervix tissues from tumour bearing patients. To highlight the Potentials of the detection of tumour antigens in tumour-faearing patients as aid to early diagnosis of the cancer, Isolation and purification of the Tumour Associated Antigens (TAA) of human cancer of the cervix were attempted by immunological and physicochemical procedures in this study. Two antigen preparations, one the Soluble Antigens (SA), and the other, the Membrane Bound Antigens (MBA) were prepared from a pool of cancer of the cervix (CaCx) tissues. The soluble antigens were extracted by homogenization in Earle’s Balanced Salt Solution (EBSS) containing antibiotics, and the membrane-bound antigens were solublised by 3-molar potassiurn Chloride (3 Molar KCl). For isolation and purification of TAA, procedures for the purification of proteins were explored. These include physicochemical stepwise ammonium sulphate fractionation, sephadex ion exchange chromatography, sephacryl S-200 gel filtration, and affinity chromatography to eliminate the normal tissue components of the antigen fractions. Hyperimmune rabbit sera were then prepared against the partially purified TAA. Immunodiffusion studies, employing hyperimmune rabbit sera prepared against the partially purified TAA were used to demonstrate tumour associated antigens in the various cancer antigen preparations, and Circulating Tumour Associated Antigens (C-TAA) in the sera of tumour- bearing patients. The TAA in the cancer tissues showed lines of identity with the C-TAA in patients sera. Techniques involving adsorption by immuno-precipitation-in-gel with Normal Cervix (NCx) tissue antigen preparations, and pooled Normal Human Sera (NHuS) were utilized for the removal of antibodies to NCx and NHuS in the rabbit sera, after which there were no reactions with NCx indicating the specificity of TAA for CaCx. A comparison of the soluble and 3 Molar KCl extracts of the cancer antigens by immuno-precipitation reaction, using adsorbed hyperimmune rabbit sera prepared against the partially purified CaCx TAA, demonstrated three TAA (TAA-1, close to the central antisera well, TAA-2, intermediate and TAA-3, close to and curving towards the peripheral antigen well) in the soluble antigen preparation. Only one TAA (probably identical to the TAA-3 of the soluble antigen) was demonstrated in the 3 Molar KCl extract. Using the rabbit antisera against the partially purified CaCx TAA, adsorbed with NCx and NHuS, results of coded sera showed that immunodiffusion reaction was able to detect circulating TAA in 75.0 per cent of patients with cancer as compared with 5.6% in women with benign gynecological diseases, 1.4% in pregnant women and 0.0% in healthy control women. The result indicates that the test has great potential for immunodiagnosis of cancer of cervix. Although the sensitivity of the test method was low, the specificity was high, and could provide a means of early diagnosis of neoplastic changes in the cervix. The detection of Circulating-TAA as tumour markers in sera of patients, may someday become routine, and thus make earlier diagnosis of cancer possible. Indications are that immuno-diagnostic procedures can be designed in ways that are reproducible, simple and reliable. Such serological tests would extend our present ability for detection and monitoring of malignancies.
A three year clinical review of the impact of angiotensin converting enzymes inhibitors on the intra hospital mortality of congestive heart failure in Nigerians
(1996) Adewole, A. D.; Ikem, R. T.; Adigun, A. Q.; Akintomide, A. O.; Balogun, M. O.; Ajayi, A. A.
Angiotensin converting enzymes inhibitors are now regarded as the cornerstone of congestive heart failure therapy owing to established reduction in mortality and the symptomatic amelioration following their use. Although the response to converting enzyme inhibitor therapy may be influenced by race, we have reported a trend to reduce intra hospital mortality, the correction of hyponatremia and shortened hospitalization in Nigerians treated with converting enzyme inhibitors. We have now conducted an extended retrospective study, to evaluate the trends in the use of enalapril or captopril and its impact on prognosis in Nigerian patients with heart failure alone, admitted between January 1992 to December 1994. The proportion of heart failure treated with (captopril or enalapril) increased from 37pc in 1992, to 50pc in 1993, to 65pc in 1994. The demographic variables and cause of heart disease were similar in patients treated with converting enzyme inhibitors (n = 55) and those treated conventionally (n = 36). The cumulative mortality among converting enzyme inhibitors treated patients, was (8/55, 14pc) compared to patients not treated (17/36, 48pc) x2 = 12.4; p < 0.0001. There was no sex predilection in mortality (M = 25pc, F = 28pc, mean 27pc). However, initial serum Na+,125mmol was significantly (x2 = 11.1; p < 0.001) more common in the dead patients, 25pc compared to the survivors discharged home 7.5pc. The median hospital stay was 17 days in captopril treated survivors (range two to 44 days) and 19 days (range four to 67 days) in conventionally treated patients. Thus converting enzyme inhibitor therapy may reduce intra hospital mortality in Black Africans hospitalized for congestive heart failure and shorten hospital stay, despite the epidemiologically low plasma renin in Blacks. Hyponatremia may be a poor prognostic index in heart failure in our patients, and its reversal by converting enzyme inhibitors may reflect neurohormonal inhibitor. Earlier and more wide spread use of angiotensin converting enzyme inhibitors in Nigerian and Black Africans with chronic heart failure is now clearly indicated.
Maternal height and prior viginal delivery as predictive factors in trail of labour after one caesarean section
(Informa Healthcare USA, Inc, 1997) Ajayi, A. B.; Babarinsa, A. I.; Adewole, I. F.
A retrospective study of 304 booked parturients with one previous lower segment caesarean section for non-recurrent indications was carried out with regards to factors predicting successful trial of vaginal delivery. The height of the parturients, as well as a history of a previous vaginal delivery appeared to be predictive factors of success. Seventy per cent of the parturients succeeded in delivering vaginally. The mean fetal birthweight was 3362 g for women with vaginal delivery, while the mean maternal height was 1.58 m. Of those who needed a repeat caesarean section, surgical intervention in 46.15% of the patients was indicated by poor cervicometric progress, which might have been appropriately addressed by oxytocin augmentation and careful monitoring in labour. Regarding prior vaginal delivery, only 31.1% of parturients with a negative history, but 63.15% with a positive history, had a successful trial. Three cases of ruptured uterus were all the result of unacceptable delay in carrying out an abdominal delivery when it was clearly indicated. A large prospective study into this aspect of obstetric care will probably define additive effects of these two definite factors.
Squamous cell carcinoma of the cervix simulating an advanced malignancy of the ovaries
(College of Medicine, University of Ibadan, Ibadan, 1998) Obisesan, K. A.; Adeyemo, A. A.; Fawole, A. O.; Adesina, O. A.
A 40-year-old woman was diagnosed as having stage II squamous cell cervical carcinoma and managed with radiotherapy. Three months after treatment, she presented with features suggestive of an advanced ovarian tumour including gross abdominal swelling, bilateral ovarian tumours, multiple tumour seedlings in the abdominal cavity and ascites. There was also pleural effusion. Operative findings revealed widespread intra-abdominal metastases whose histology, contrary to expectations, showed squamous cell carcinoma of cervical origin. Distant metastases from squamous cell carcinoma of the cervix are rare. A high index of suspicion is necessary to detect this unusual mode of presentation.
Complete hydatidiform mole co-existing with a twin live fetus
(2001) Obisesan, K. A.; Adesina, O. A.; Awolude, O. A.
Rectovaginal and vesicovaginal communications following coital injury
(2001) Odukogbe, A. A.; Onifade, R. A.; Adewole, I. F.; Adesina, O. A.; Awolude, O. A.
Complete hydatidiform mole co-existing with a twin live fetus
(Taylor and Francis, 2001) Obisesan, K. A.; Adesina, O. A.; Awolude, O. A.
Rectovaginal and vesicovaginal communications following coital injury
(Taylor and Francis, 2001) Odukogbe, A. A.; Onifade, R. A.; Adewole, I. F.; Adesina, O. A.; Awolude, O. A.
Sixty-one day twin to twin birth interval in a low technology setting
(College of Medicine, University of Ibadan, Ibadan, 2002) Odukogbe, A. A.; Adesina, O. A.; Babarinsa, I. A.; Onifade, R. A.; Adewole, I. F.
Multiple pregnancy, whether spontaneous or from artificial reproductive techniques, is regarded us high risk. Limiting the twin-twin birth interval to within 30 minutes has been widely practised. However, conservative management of the retained live, immature second twin may be worthwhile. We report a case lasting sixty-one days in a low technology setting.
Fetal macrosomia at the University College Hospital, Ibadan: a 3-year review
(Taylor and Francis, 2003) Adesina, O. A.; Olayemi, O.
The study aimed to determine the maternal characteristics and contribution to obstetric morbidity of infants presenting with fetal macrosomia at the University College Hospital, Ibadan. This was a retrospective study. Obstetric data of the mothers were extracted from the casenotes and analysed. Fetal characteristics such as sex and weight, and perinatal complication were also analysed. The maternal characteristics that were significantly different in the study and control groups were parity, term weight ≥90 kg, previous history of fetal macrosomia and mean duration of pregnancy. There was no significant difference in maternal age or height. The incidence of caesarean section was three times more common in the study group. There were three cases of shoulder dystocia in the study group but none in the control group. The mean birth weight of macrosomic babies delivered by section or macrosomic babies that died was higher than the mean birth weight of macrosomic babies delivered per vagina or that survived. Severe asphyxia at 1 minute was significantly higher in the study group. Perinatal mortality among macrosomic babies was 11.4/1000. There was no mortality in the control group. It is suggested that clinical suspicion of macrosomic based on risk factors such as those identified in this study may be found useful in antenatal prediction.
Pregnancy outcome in diabetic patients at University College Hospital, Ibadan
(2003-04) Oladokun, A.; Aimakhu, C. O.; Aimakhu, C. O.; Awolude, O. A.; Olayemi, O.; Adeleye, J.
Context: Diabetes mellitus is one of the common medical complications in pregnancy, which if not properly controlled, can lead to significant perinatal and maternal morbidity and mortality. Objective: To determine the incidence of diabetes mellitus in pregnancy in this centre, and to assess the effect of maternal glucose control on the obstetric performance as well as perinatal outcome of pregnant diabetics managed at the University Collage Hospital, Ibadan. Study Design: A review of the obstetric outcome for 49 diabetic women who delivered at the University College Hospital, U.C.H, Ibadan, Nigeria during a 1 0-year period (January, 1991 t o D ecember 2 000) i s presented. Results: The incidence rate of diabetes in pregnancy was 0.74 per 1000 deliveries per year. Most patients (89.8%) booked for antenatal care and delivery in this centre. Good control was achieved in 77.6% of patients and the mean birth weight was 3.37 ± 1.52kg. There was no significant difference in the birth weight and fetal outcome if a patient had pre-existing or gestational diabetes. However, the outcome was significantly related to the level of control. With good control there was a better Apgar score at 5 minutes, which was prognostic for fetal outcome. The perinatal mortality rate was 98/1000 births and this was significantly associated with poor control when compared with good control (p < 0.05). There was no maternal death. Conclusion: Further improvement in the management is needed. Preconception control, early antenatal booking and good control in pregnancy are strongly advocated as means of achieving good pregnancy outcome.
Cervical cytology service in Nigeria: providers’ perspective
(Taylor and Francis, 2003-07) Adesina, O. A.; Babarinsa, I. A.; Fawole, A. O.; Oladokun, A.; Adeniji, R. A.; Adewole, I. F.
It has been noted that efforts to organise an effective screening programme in developing countries will have to find adequate financial resources, develop the infrastructure, train the necessary manpower and elaborate surveillance mechanisms. In our study, we set out to determine (a) just how frequent is cervical cancer, to warrant the investment of funds in screening programmes; (b) what proportion of surveyed health facilities offer a cervical cytology screening programme; and (c) what basic facilities are currently available where such programmes exist? A pretested, self-completed questionnaire was sent to heads of department of obstetrics and gynaecology in public tertiary and secondary care hospitals in Nigeria as well as major mission hospitals. The response rate was 63%, monthly consultations included a mean of 114 (±11.7) new gynaecological patients and an average of 5 (4.7±0.8) cervical cancer cases. One-half of the institutions had a hospital-based cervical screening programme with an average of 27 patients being screened monthly. Finance was the main difficulty encountered in maintaining a screening service. Only four had a certified gynaecological oncologist. In conclusion, there is dismal utilization of available services and a dearth of trained specialists should any cervical cancer screening programme be considered.
Evaluation of VCT in a Nigerian PMTCT service delivery unit
(2004) Adewole, I.; Adesina, A.; Onibokun, A.; Adebusuyi, A.; Kayode, A.; Osofisan, E.; Fawemida, A.; Kanki, P.; Sankale, J.
Introduction: Nigeria’s University College Hospital’s PMTCT centre provides voluntary counselling and testing as part of routine care which was assessed in this paper. Methods: Structured face-to-face interview was carried out at exit on participants from the counselling session. Data analysis was by frequency distribution. Results: All clients were assured of confidentiality, had their HIV/ AIDS knowledge assessed and consent taken before the test, 95.45% of participants had the possible outcomes of the test explained including coping ability and 13.64% did not have behaviour assessed for risk taking. Only 45.45% mentioned mother-to-child transmission as a major mode of transmission. Conclusion: Discussion of serostatus results in a safe setting and negotiating a risk -reduction plan are strategies that should be considered in all PMTCT services.
Sources of contraceptive commodities for users in Nigeria
(2005) Oye-Adeniran, B. A.; Adewole, I. F.; Umoh, A. V.; Oladokun, A.; Gbedegesin, A.; Odeyemi, K. A.; Ekanem, E. E.
"Background:Understanding the sources of contraceptive commodities is an important aspect of the delivery of family planning services and is required by planning programme managers for strategic planning purposes. Findings from the 2003 Nigeria Demographic and Health Survey have previously showed that the private sector was the most frequently reported source of contraceptive supply, providing contraception to two and a half times as many women as the public sector. We conducted a community-based study to examine further the sources of contraceptive commodity for users in Nigeria with a view to identifying their preferences for distribution centres. This information would be useful to improve commodity distribution and to build the necessary capacity for satisfactory delivery of contraceptives. Methods and Findings:A multi-stage random sampling technique was used. A state was randomly selected to represent each of the four health zones in Nigeria. Two local government areas (LGAs) were then selected representing both urban and rural areas. Ten enumeration areas were subsequently selected from each LGA. Of the 2,001 respondents aged 15–49 years, 1,647 (82.3%) were sexually active, out of which 244 were found to be using contraceptive methods at the time of the study, giving a contraceptive prevalence of 14.8%. The commonest source of information on contraceptives was through friends (34%), followed by the radio (11.5%) and husbands (10.2%). Most respondents procured their contraceptives from chemist/patent medicine shops (19.7%), while only 0.8% obtained them from designated family planning clinics. The younger groups in this study (15–24 years), single people, Catholics, and Muslims, showed a greater preference for chemist/patent medicine shops for their sources of contraceptives. The older groups and married respondents, however, made use of government and private hospitals to obtain their contraceptives. Conclusion:Strategies to increase contraceptive use must take into consideration these identified sources of contraceptives with a view to enhancing the quality, quantity, and variety of methods available, and to building capacity for effective service delivery. There is also a need to encourage the establishment of adolescent-friendly clinics where young people can go for counselling and obtain contraceptives of their choice, including emergency contraceptive pills."
Screening for premalignant lesion of the cervix: determinants of patients’ practices
(2005) Awolude, O. A.; Adesina, O. A.; Oladokun, A.; Adewole, I. F.
Assessment of tubal factor contribution to female infertility in a low resource setting (southwest Nigeria): hysterosalpingography vs laparoscopy
(2005) Okunlola, M. A.; Adebayo, O. J.; Odukogbe, A. A.; Morhason-Bello, I. O.; Owonikoko, K. M.
The challenges of single-short spinal anaesthesia for caesarean section in a morbidly obese patient: a case report
(2005-10) Danladi, K. Y.; Sotunmbi, P. T.; Awolude, O. A.; Obisesan, K. A.
An unusual case of morbid obesity, severe hypertension and twin gestation at 36weeks in an unbooked multigravid patient was presented for cesarean section. She was referred from a private clinic to the obstetric emergency unit of the University College Hospital, Ibadan with history of hypertension in pregnancy. She was a known hypertensive for ten years and her blood pressure was poorly controlled due to non-compliance with medications and medical check-up. She had been having progressive visual loss over the ten year period and had lost three, previous pregnancies. Following comprehensive clinical and radiological evaluation, she had a carefully planned single-shot spinal anaesthesia for cesarean delivery of a set of twin which was performed on a double operation table. She remained stable throughout the procedure and post operative period.
Unwanted Pregnancy and induced abortion in Nigeria: causes and consequences.
(2006) Bankole, A.; Oye-Adeniran, B. A.; Singh, S.; Adewole, I. F.; Wulf, D.; Sedgh, G.; Hussain, R.
Discontinuation pattern of norplant among implant acceptors at the family planning clinic, University College Hospital, Ibadan, Nigeria
(2006) Okunlola, M. A.; Owonikoko, K.M; Adekunle, A O. .; Morhason-Bello, I. O.
This is a retrospective study of 136 Norplant acceptors. We assessed the reasons for the discontinuation during the prescribed 5-year period of use. The continuation rates for the first, second and third years were 94.1%, 83.8%, and 79.4% respectively. The commonest reason for discontinuation was menstrual irregularities (40.43%) of clients followed by the desire for pregnancy in 29.79%. Contraceptive failure as a reason for discontinuation of Norplant use was not recorded in any of the clients in this series. In conclusion, ii is our belief that to sustain high continuation rates of Norplant use the clients require proper and effective counselling and support on the side effects of irregular bleeding patterns, which when occurs will be better coped with